Wisconsin state officials are dictating to state HMOs that changes be made in how care is delivered in the state's Medicaid/BadgerCare Plus program. Faced with unacceptable HMO quality scores as well as a mandate to cut up to $600 million in costs from its Medicaid program, the state's Department of Health Services has announced it will end its existing BadgerCare Plus contracts with HMOs in six southeastern Wisconsin counties, setting the stage for a competitive bidding process for the region's business. An RFP will be issued this fall, with new contracts in place by July 2010. The re-bid contracts cover about 230,000 managed care lives. Meanwhile, Wisconsin HMOs are awaiting final regulations on a new state mandate that requires them to cover intensive in-home therapy for autism. On the prescription drug front, state HMOs are facing the specter of rising specialty drug costs and are implementing a variety of strategies to control those costs. The state received a dose of good news when the administration of President Barack Obama approved the state's Pharmacy Plus waiver for its popular SeniorCare program. The program is the only one of its kind in the nation and in essence competes with the federal Medicare Part D program.